RADIOLOGICAL

INVESTIGATIONS

ULTRASONOGRAPHY

DR. NIRATH S HEGDE

WHAT IS ULTRASONOGRAPHY?

• Ultrasonography (USG) is application of medical with

ultrasound-based imaging diagnostic technique used to
visualize internal organs, their size, structure and their
pathological lesions.
• Ultrasonography is widely utilized in medicine, primarily
in gastroenterology, cardiology, gynecology and
obstetrics, urology and endocrinology. It is possible to
perform diagnosis or therapeutic procedures with the
guidance of ultrasonography (for instance biopsies or
drainage of fluid collections).
WHAT IS ULTRASOUND?

In physics, the term "ultrasound" applies

to all acoustic energy (longitudinal,
mechanical wave) with a frequency above
the audible range of human hearing. The Ultrasound is defined as high-frequency
audible range of sound is 20 hertz-20 sound waves of 20 thousand to 1 million Hz
(cycles per second) or greater. (Each peak in
kilohertz. Ultrasound is frequency a sound wave represents one cycle.)
greater than 20 kilohertz.
Diagnostic ultrasound operates between 3.5
and 10 million Hz (3.5 and 10 MHz).
PARTS OF USG SCAN MACHINE
HOW DOES ULTRASOUND WORK?
• Ultrasound imaging is based on the same principles
involved in the sonar used by bats, ships, fishermen and
the weather service.
• When a sound wave strikes an object, it bouncesback, or
echoes.
• By measuring these echo waves, it is possible to
determine how far away the object is and its size, shape
and consistency (whether the object is solid, filled with
fluid, or both).
• In medicine, ultrasound is used to detect changes in
appearance of organs, tissues, and vessels or detect
abnormal masses, such as tumors.
HOW DOES ULTRASOUND WORK?

• Ultrasound is created by the high-frequency vibration of a crystal located in the

ultrasound transducer, which is a piece of equipment about the size of a small cell
phone that fits easily into the hand.
• The soft, curved end of the transducer is placed on the patient, and gel is used to
improve its contact with the skin.
• During the scanning process, the crystal is stimulated electronically to vibrate. This
occurs in an instant, and the crystal then becomes a listening device for the returning
echoes from ultrasound reflected back by body tissues.
• These returning echoes are converted to a gray scale for the creation of an
ultrasound image.
HOW IS AN IMAGE CREATED WITH
ULTRASOUND?
• As the ultrasound energy travels through tissues of the body, it is scattered,
transmitted, or reflected back to the transducer.
• Ultrasound that is scattered does not help to create an image.
• Ultrasound that is transmitted produces an echo-free area on the image.
• Fluid such as ascites, bile within the gallbladder, and serous water within a cyst all
appear as sonolucent (echo-free and black on the film) areas on the ultrasound image.
• Reflected ultrasound creates a density on the ultrasound image (gray or white on the
film).
• The difference in how much ultrasound a given tissue reflects allows us to see
individual structures. For example, the pancreas reflects more ultrasound (is more
echogenic) than the liver, the liver reflects more than the spleen, and the spleen reflects
more than the kidneys.
Important term
POSTERIOR
ACOUSTICAL
SHADOWING
When ultrasound hits a
dense object such as a
gallstone and is
completely reflected, a
posterior acoustical
shadow is formed. The
gallstone is bright and
echogenic. Because no
ultrasound energy is
left to go beyond the
stone, an echo void is
created, which appears
as a wedge-shaped
dark area posterior to
the dense object.
 Important term
INCREASED
THROUGH
TRANSMISSION
When ultrasound
passes through a
fluid medium, the
intensity of the
sound energy is not
diminished.
Therefore, tissues
behind the fluid
collection are more
echogenic (brighter
because there is
more acoustic
power to reflect
back to the
transducer).
 
ULTRASOUND IMAGING MODES

GREY SCALE IMAGING DOPPLER IMAGING

A-Mode  Continuous waveDoppler
B-Mode  Power Doppler
M-Modern  Color Doppler
 Duplex Doppler
 Pulsed waveDoppler
 A MODE

 Simplest form of ultrasound imaging which

is based on The pulse-echo principle.
 A scans can be used to measure distances.
 A scans only give one dimensional
information
 Not so useful for imaging
 Used for echoencephalography and
echoophthalmoscopy
 B MODE

 B stands for Brightness

B scans give two dimensional information about the
cross section.
Generally used to measure cardiac chambers
dimensions, assess valvular structure and function.
 M MODE

 M stands for motion

 This represents movements of
structures over time.
 M Mode is commonly used for
measuring chamber dimensions.
 This is analogous to recording a video
in ultrasound.
 DOPPLER IMAGING

 It is a general term used to visualize

velocities of moving tissues.
 Doppler ultrasound evaluates blood
velocity as it flows through a blood
vessel.
 Blood flow through the heart and large
vessels has certain characteristics that
can be measured using Doppler
instruments.
 DOPPLER IMAGING

• Direction and velocity of blood flow can be determined by analyzing changes in the
frequency of sound waves:
• If a reflected sound wave is lower in frequency than the transmitted sound wave,
blood flow is away from the transducer.
• If a reflected sound wave is higher in frequency than the transmitted sound wave,
blood flow is toward the transducer.
• The magnitude of the change in frequency is proportional to blood flow velocity.
• Changes in frequency of the reflected sound waves are converted into images
showing blood flow direction and velocity.
 DOPPLER IMAGING
• For color Doppler ultrasonography, color is superimposed on a grayscale anatomic
image.
• The color indicates direction of blood flow.
• By convention,
• red indicates flow toward and
• blue indicates flow away from the transducer.

• Doppler ultrasonography is also used to evaluate vascularity of tumors and organs, to

evaluate heart function (e.g., as for echocardiography), to detect occlusion and stenosis
of blood vessels, and to detect blood clots in blood vessels (e.g., in deep venous
thrombosis).
 WHEN IS ULTRASOUND MOST USEFUL?

• As a general rule, ultrasound is best at distinguishing the characteristic echo-free

appearance seen in fluid collections or cysts.
• It works best on thin patients and on body parts closest to the skin.
• Ultrasound does not work well in the presence of gas or air or in larger patients.
 WHAT ARE SOME COMMON USES OF
USG?
• Ultrasound examinations can help to diagnose a variety of conditions and to assess organ
damage following illness, visualizing subcutaneousbody structures including tendons,
muscles, joints, vessels and internal organs for possible pathology or lesions different
with obstetric sonography is commonly used during pregnancy and is widely recognized
by the public.
• Ultrasound is used to help physicians evaluate symptoms such as:
• pain
• swelling
• infection
• hematuria (blood in urine)
 WHAT ARE THE REGIONS OF THE BODY AND/OR
DIAGNOSES BEST IMAGED WITH ULTRASOUND?
• Appendicitis • Pregnancy
• Breast • Scrotum
• Female pelvis • Soft tissue masses
• Gallbladder • Thyroid
• Heart • Upper abdomen
• Kidneys • Vascular structures (venous and
• Neonatal brain arterial)
• Pleural effusion
 WHAT ARE SOME OTHER USES OF USG?
Ultrasound is also used to:
• • guide procedures such as needle biopsies, in which needles are used to extract sample cells from an
abnormal area for laboratory testing.
• • image the breasts and to guide biopsy of breast cancer
• • diagnose a variety of heart conditions and to assess damage after a heart attack or diagnose for valvular
heart disease.
• Ultrasound is sometimes used to clean teeth in dental hygiene.
• Ultrasound may be used for cataract treatment by phaco emulsification.
• Focused ultrasound may be used to break up kidney stones by lithotripsy.
• Focused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or
malignant), This is known as Focused Ultrasound Surgery (FUS) or High Intensity Focused Ultrasound
(HIFU).
 WHAT ARE SOME OTHER USES OF USG?

Doppler ultrasound images can help the physician to see and evaluate:
• blockages to blood flow (such as clots)
• narrowing of vessels (which may be caused by
plaque).
• tumors and congenital vascular malformation.

With knowledge about the speed and volume of blood flow gained from a Doppler ultrasound
image, the physician can often determine whether a patient is a good candidate for a procedure
like angioplasty.
OBSTETRIC USG

Obstetric sonography (ultrasonography)

is the application of medical
ultrasonography to obstetrics, in which
sonography is used to visualize the embryo
or fetus in its mother's uterus (womb). The
procedure is often a standard part of
prenatal care, as it yields a variety of
information regarding the health of the Obstetric sonogram of a baby at 16 weeks. The
mother and of the fetus, as well as bright white circle center-right is the head, which
faces to the left. Features include the forehead at 10
regarding the progress of the pregnancy.
o'clock, the left ear toward the center at 7 o'clock
and the right hand covering the eyes at 9:00.
OBSTETRIC USG

Sonogram of male baby, Baby at 14 weeks

with scrotum and penis in
center of image
OBSTETRIC USG
USG APPLICATION IN CARDIOLOGY
USG APPLICATION IN INTERNAL MEDICINE
USG APPLICATION IN INTERNAL MEDICINE
USG APPLICATION IN MUSCULOSKELETAL
SYSTEM
USG APPLICATION IN MUSCULOSKELETAL
SYSTEM
 ADVANTAGES OF USG?

• It images muscle and soft tissue very well and is particularly useful for delineating the
interfaces between solid and fluid-filled spaces.
• It renders "live" images, where the operator can dynamically select the most useful section
for diagnosing and documenting changes, often enabling rapid diagnoses.
• It shows the structure as well as some aspects of the function of organs.
• It has no known long-term side effects and rarely causes any discomfort to the patient.
• Equipment is widely available and comparatively flexible; examinations can be performed
at the bedside.
 DISADVANTAGES OF USG?

• Ultrasound cannot penetrate bone and performs poorly when there is air between the
scanner and the organ of interest. For example, overlying gas in the gastrointestinal tract
often makes ultrasound scanning of the pancreas difficult.
• Even in the absence of bone or air, the depth penetration of ultrasound is limited, making
it difficult to image structures that are far removed from the body surface, especially in
obese patients.
• The method is operator-dependent. A high level of skill and experience is needed to
acquire good-quality images and make accurate diagnoses.
 RISKS AND SIDE EFFECTS OF USG?

• Ultrasonography is generally considered a "safe" imaging modality.

• This diagnostic procedure should be performed only when there is a valid medical
indication, and the lowest possible ultrasonic exposure setting should be used to gain the
necessary diagnostic information under the "as low as reasonably achievable" or ALARA
principle.
• World Health Organizations technical report series 875(1998).supports that ultrasound is
harmless: "Diagnostic ultrasound is recognized as a safe, effective, and highly flexible
imaging modality capable of providing clinically relevant information about most parts
of the body in a rapid and cost-effective fashion".
THANK YOU